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Betancourt CA, Goldberg DG, Hawks BA, Kitsantas P. Perspectives of homeless veterans living with substance use disorders (SUD) and mental illness. Heliyon 2023; 9:e20364. [PMID: 37767504 PMCID: PMC10520805 DOI: 10.1016/j.heliyon.2023.e20364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Upon returning home from the military, America's veterans face complex challenges such as homelessness and substance use disorders (SUD). Veterans who have experienced SUDs and homelessness are more likely to struggle with depression and suicidal behaviors. This study aims to understand homeless veterans' lived experiences of their everyday life and social interactions. We used semi-structured interviews to conduct a phenomenological study of 14 homeless veterans with known SUDs living in the Baltimore-Washington D.C. Metropolitan area. A Social-Ecological Model (SEM) was used to create themes, a priori, then used open coding analytic methods to identify emerging themes. Two-thirds of veterans used illicit drugs or abused alcohol, and nearly all reported a history of depression or anxiety. Suicidal behaviors were present in a third of all veterans. We found that veteran homelessness and substance use are strongly associated with emotional and physical trauma suffered while on active duty. Consequently, once homeless, a veteran's community may encourage and exacerbate SUDs, thus impeding a path toward sobriety. Homeless veterans who have struggled with SUDs and later experience a death in their family often relapse to substance use. Deeply exploring a veteran's relationships with family, friends, and their immediate community may reveal opportunities to address these issues using healthcare and community interventions.
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Affiliation(s)
- Christian A. Betancourt
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Debora G. Goldberg
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA, 22032, USA
| | - Beth A. Hawks
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Panagiota Kitsantas
- Department of Population Health and Social Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
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Amaro H, Kong Y, Marsh JC, Khachikian T, Guerrero EG. Identifying gender differences in risk profiles and in opioid treatment outcomes in Los Angeles County. EVALUATION AND PROGRAM PLANNING 2023; 97:102240. [PMID: 36702006 PMCID: PMC10121834 DOI: 10.1016/j.evalprogplan.2023.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Policies and programs that aim to minimize wait time to enter opioid use disorder (OUD) treatment and maximize retention respond to potential differences in female and male clients' risk profiles. We conducted multigroup latent class analysis using significant individual risk factors. Our sample included 13,453 opioid treatment episodes from 135 unique substance use disorder treatment programs in Los Angeles County, California, in four waves: 2011 (66 programs, 1035 clients), 2013 (77 programs, 3671 clients), 2015 (75 programs, 4625 clients), and 2017 (69 programs, 4106 clients). Groups at risk of waiting longer included clients who were female, had mental health issues, received medication for OUD, had criminal justice involvement, received mandated referrals, had children in child protective services, and had caretaker responsibilities. All clients with children in protective services were likely to wait longer than those not in protective services, but women waited longer. Findings highlight that: (a) women and men in OUD treatment have significant health and social problems; (b) female and male clients have distinct risk profiles; and (c) targeted services responding to risk profiles may improve treatment access and engagement. Findings have implications for health policy and program evaluation and planning in the delivery of treatment services considering gendered risk factors.
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Affiliation(s)
- Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, FL 33199, United States
| | - Yinfei Kong
- California State University, Fullerton College of Business and Economics, 800 N State College Blvd, Fullerton CA 92831, United States
| | - Jeanne C Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Erick G Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025, United States.
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Grisamore SP, Nguyen RL, Wiedbusch EK, Guerrero M, Cope CEA, Abo MG, Jason LA. Journey to wellness: A socioecological analysis of veterans in recovery from substance use disorders. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:394-406. [PMID: 35848150 DOI: 10.1002/ajcp.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/20/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Substance use disorders are increasingly prevalent among veterans in the United States. Veterans in recovery face unique challenges, such as high rates of psychiatric comorbidities, difficulties adjusting to civilian life, and inadequate housing and mental health services. While prior research has explored veterans' experiences in recovery, studies have not implemented a multilevel perspective in their analyses. The current qualitative study examined how individual veteran experiences intersect with interpersonal and systemic factors. Semistructured focus groups were conducted with veterans who were former or current residents of recovery homes (N = 20). Thematic analysis was utilized to explore veterans' personal experiences through the CHIME-D framework (connectedness, hope & optimism, identity, meaning in life, empowerment, and difficulties). The data were further analyzed within a socioecological model (intrapersonal, interpersonal, and community). Each component of the CHIME-D framework was salient across all focus groups, with connectedness, empowerment, and difficulties being the most prominent themes that occurred across all socioecological levels. Results suggest that recovery initiatives can effectively assist veterans by promoting empowerment, facilitating social connections, and addressing cooccurring difficulties across multiple socioecological contexts. Additionally, treatment programs should encourage veterans to take on meaningful roles in their communities. Future research should continue to explore veterans' recovery experiences using a socioecological model.
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Affiliation(s)
- Simone P Grisamore
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca L Nguyen
- Department of Psychology, University of Maryland, Baltimore County, Maryland, USA
| | - Elzbieta K Wiedbusch
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
| | - Mayra Guerrero
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Carlie E A Cope
- Department of Learning Sciences, Georgia State University, Atlanta, Georgia, USA
| | - Mary G Abo
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Medina S, Van Deelen A, Tomaszewski R, Hager K, Chen N, Palombi L. Relentless Stigma: A Qualitative Analysis of a Substance Use Recovery Needs Assessment. Subst Abuse 2022; 16:11782218221097396. [PMID: 35664045 PMCID: PMC9160899 DOI: 10.1177/11782218221097396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Substance use disorders (SUD) pose emotional, mental, and physical threats to persons worldwide. There is a paucity of research focused on capturing individual perspectives on supports and barriers to recovery from a SUD. This need has been identified in areas of Minnesota where a gap in evidence-based substance use support exists. A team of interdisciplinary professionals distributed a qualitative survey assessing supports and barriers to SUD recovery within recovery circles in order to inform the efforts of local organizations. This paper and online access survey was adapted from an existing survey created by Faces and Voices of Recovery. The online survey was accessed by a link and distributed to persons in recovery across Minnesota over 7 months. Data from this survey were analyzed through a consensual qualitative research (CQR) coding method. Notable themes emerged in the following domains: healthcare, environment, individual, and community. Community-wide stigma was an overarching concern, and the study yielded unique insights into stigma within healthcare and the community at-large. Barriers and support to recovery were reported. Barriers included experiencing high levels of stigma and identifying a need for community education on SUDs and recovery. Support included local recovery groups, peer recovery support, and access to healthcare and medication. Our findings illuminate the needs of the recovery community from the perspective of individuals with lived experience and will inform local organizations in specifying resources to help meet the identified needs. This survey may also be adapted and used around the world to inform substance use prevention, treatment, and recovery programing.
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Affiliation(s)
- Stephany Medina
- South Dakota State University – University of South Dakota Joint Master of Public Health Program, Brookings, SD, USA
| | - Anna Van Deelen
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Robyn Tomaszewski
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Keri Hager
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Nathaniel Chen
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Laura Palombi
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
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